The migration of healthcare workers from low and middle-income countries (LMICs) to high-income countries (HICs) — the so-called “medical brain drain” — is not a new phenomenon. But its scale and impact have reached a point where we can no longer turn a blind eye.

Consider this: some HICs draw as much as one-fifth of their physician workforce from LMICs. This exodus is happening against a backdrop of a global shortage of 2.8 million physicians, with LMICs bearing the brunt of this deficit. It’s akin to siphoning water from a drought-stricken village to fill swimming pools in wealthy neighbourhoods.

The drivers of this migration are complex. Healthcare workers often cite poor working conditions, limited career advancement opportunities, and socioeconomic challenges in their home countries as push factors. As one study notes, “the top five reasons for respondents choosing to emigrate from their home country were: socioeconomic or political situations in their home countries; better education for children; concerns about where to raise children; quality of facilities and equipment; and opportunities for professional advancement.”.

But the consequences are far from complex — they are devastatingly clear. Beyond the immediate loss of skilled professionals, there are significant economic costs to LMICs. A study by Saluja et al. estimated that “LMICs lose nearly US$16 billion annually (95% CI $3.4 to $38.2) due to the cost of excess mortality that results from physician migration to HICs.” This figure represents the direct financial investment in training these professionals and the potential lives lost due to their absence.

The impact on healthcare systems in source countries is equally severe. As Misau et al. point out, “The health care system in the developing countries faces many problems, human resource being one of the majors. The system is structurally and systemically fragile and weak to provide effective service where it most needs. Brain drain appears to have complicated the situation and made matters worse.”

It’s easy to point fingers at HICs for “stealing” healthcare workers from LMICs. But this oversimplifies a complex issue. Many argue that individuals can seek better opportunities and living conditions for themselves and their families. One commentary notes, “when health-workers leave, they exercise their autonomy in pursuing their life plans; the freedom to leave one’s country and free choice of profession are codified as human rights in the UDHR.”.

So, what’s to be done? The World Health Organization has developed a global code of practice for the international recruitment of health personnel. But as Brugha and Crowe point out, “the code is ultimately voluntary. Recent research has suggested a lack of awareness of the code among relevant stakeholders and that the code has not affected policies, practices, or regulations in Canada or other developed countries.”

LMICs need to implement strategies to retain their healthcare workers. Kamarulzaman et al. suggest, “Investing in and strengthening domestic health care, providing career opportunities and attractive remuneration, and investment in research and development in a context of political stability are necessary to attract and retain health workers.”

But HICs cannot absolve themselves of responsibility. Ethical recruitment practices, support for health system strengthening in LMICs, and partnerships for medical education and training can help mitigate the negative impacts of healthcare worker migration.

The current situation is unsustainable and detrimental to global health equity. As Eaton et al. argue, addressing this issue requires “a comprehensive approach that considers the rights and aspirations of individual healthcare workers, the needs of source countries, and the ethical responsibilities of destination countries.”

The medical brain drain is not just a problem for LMICs — it’s a global health emergency. And like all emergencies, it demands immediate, concerted action. The health of millions depends on it.

The post Medical Brain Drain: A Global Health Emergency We Can No Longer Ignore appeared first on Medika Life.

MCLEAN, Va., & BEDFORD, Mass.–(BUSINESS WIRE)–A new MITRE-Harris Poll Survey on Patient Experience finds 52 percent of individuals in the United States feel their symptoms are “ignored, dismissed, or not believed” when seeking medical treatment. That number rises to 6-in-10 within the Hispanic community.

“And these categories are, of course, intersectional. There’s no question there is work to do to better serve all populations at the point-of-care.”

The polling also revealed that more than half of Blacks and Hispanics feel the “healthcare provider is biased against me based on their attitude, words, or actions,” contributing to a 4-in-10 average across all demographics. Fifty percent (50%) of respondents also reported “a healthcare provider assuming something about me without asking me.”

Additionally, the results indicate that several groups are all much more likely to experience bias, doubt, or language barriers when seeking treatment. These include individuals identifying as a person with a disability or having a chronic health condition, those responsible for managing access to healthcare for a family member or friend, and members of the LGBTQ+ community.

“These findings confirm unacceptable disparities in patient experience along racial and ethnic lines, for the LGBTQ+ community, and for those who are managing chronic health conditions or navigating the world with disabilities,” said Juliette Forstenzer Espinosa, senior Medicare, Medicaid, and Affordable Care Act Marketplace strategist, MITRE. “And these categories are, of course, intersectional. There’s no question there is work to do to better serve all populations at the point-of-care.”

Rob Jekielek, managing director, The Harris Poll, said, “With the evolution of online patient portals and digital support tools, we have seen stronger usage among those who need to navigate the system the most—individuals with a chronic illness or disability and those who manage the healthcare needs of others. However, this has not translated to substantially lower frustration with the healthcare system, including understanding of coverage and claims. Confusion and uncertainty are even higher among the majority of Americans who use the system sporadically, or only when specific needs arise.”

Additional key findings from the MITRE-Harris Poll Survey include:

• When consumers have a concern or question about a bill, they struggle with whom to call.
  Fifty-four percent (54%) of insured individuals in the United States say they don’t know whom to contact if they have an issue with a bill or claim. Individuals self-identifying as disabled or dealing with chronic illness, caregivers, Hispanics, and younger generations are more likely to say they do know whom to contact if they have issues.
• Prevalence of unexpected medical bills decreases slightly.
  Forty-three percent (43%) of insured Americans report receiving an unexpected bill because their insurance did not cover as much as expected – a decrease from a 2021 MITRE-Harris Poll Survey when 47 percent reported a billing surprise.
• Patients are overwhelmingly using portals.
  Nearly 9-in-10 insured individuals use online patient portals more often for test results (70%), appointments (64%), and medical records (63%) than for other applications, such as finding a healthcare provider (58%), reviewing insurance benefits (54%), managing prescriptions (54%), or filing a health insurance claim (37%). Insured Black, Indigenous, and people of color (BIPOC) groups are more likely than white individuals to use patient portals to find a healthcare provider or file a claim.
• Patients seeking some specialists may wait two months or more for a visit.
  While most Americans can schedule an imaging appointment or a visit with their primary care provider or general practitioner in less than two weeks, 1-in-5 say it can take two months or more to meet with specialized professionals such as mental health providers, specialty physicians, dentists, or optometrists.

Methodology

This survey was conducted online within the United States, September 27-29, 2022, among 2,047 adults (ages 18 and over) by The Harris Poll on behalf of MITRE via the Harris On Demand omnibus product.

Editor’s Notes:

• Survey findings and commentary slide presentation is available by request to media@mitre.org.
• Health Insurance Marketplace open enrollment runs from November 1, 2022 to January 15, 2023.

About The Harris Poll

The Harris Poll is one of the longest-running surveys in the U.S. tracking public opinion, motivations, and social sentiment since 1963, and is now part of Harris Insights & Analytics, a global consulting and market research firm that delivers social intelligence for transformational times. We work with clients in three primary areas: building twenty-first-century corporate reputation, crafting brand strategy and performance tracking, and earning organic media through public relations research. Our mission is to provide insights and guidance to help leaders make the best decisions possible. To learn more, please visit www.theharrispoll.com.

About MITRE

MITRE’s mission-driven teams are dedicated to solving problems for a safer world. Through our public-private partnerships and federally funded R&D centers, we work across government and in partnership with industry to tackle challenges to the safety, stability, and well-being of our nation. Learn more at mitre.org.

©2022 MITRE #22-4132 12-15-2022

Contacts

Media
Mike Murphy, external communications principal, MITRE media@mitre.org.

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Researchers are waking up, but in the meantime, women suffer. A recent newspaper article summed up part of the problem.

A survey by ResearchGate, a social networking site for researchers, of studies on the site found five times more research on erectile dysfunction, which affects 19 per cent of men, than on premenstrual syndrome, which affects 90 per cent of women.

The journey I had may serve as an illustration of medical information neglect. I was taken from a train at Grand Central Station in NYC, hauled off to the downstairs medical office, and scoffed and scolded by a nurse who said I would have to be quiet and lie there. OK, perhaps they had nothing for me in terms of a pill, but a few comforting words might have helped.

I had doubled over on the train, nauseous, unable to walk because of the intense pain, and this was the care I got. Hours later, I would be put on another train to go home alone after they gave me aspirin.

It wouldn’t be the first time the pain had incapacitated me, nor the only time I couldn’t go to work that day because of it. I’d suffer with it despite many visits to various physicians and medical centers. One famous NYC gynecologist insisted she’d only prescribe birth control pills to control the pain — didn’t help, but she refused anything else.

The situation in the professional literature is summed up as follows:

Primary dysmenorrhea, or painful menstruation in the absence of pelvic pathology, is a common, and often debilitating, gynecological condition that affects between 45 and 95% of menstruating women. Despite the high prevalence, dysmenorrhea is often poorly treated, and even disregarded, by health professionals, pain researchers, and the women themselves, who may accept it as a normal part of the menstrual cycle.

Yes, I’ve even had to depend on the kindness of strangers. Once, while at work, the pain and lowering of my blood pressure struck, and I had to go home via subway that time. Of course, to get to my home in my mother’s house, I’d have to change trains, and that was where a kindly Black woman came to my aid.

She saw how I looked and that I couldn’t possibly walk up the two flights of stairs to the next train, so she called my mother and asked her to come to get me. “I’ll stay with you until your mother arrives,” she said, and we sat on a bench together. We didn’t speak but knowing she was there provided more comfort than I had ever received while in this state. My mother came, and the woman left with a wish for me to feel better. I will never forget her.

After the unsatisfying appointment with the NYC OB/GYN (featured in Cosmo, BTW), I tried a major NYC medical center. The physician there told me he would be “your doctor now” and proceeded to put me into a clinical trial and “treat” me with a diuretic medication that lowered my potassium levels. Do you know what that does? It does nothing for menstrual pain, but it brings on a host of other problems instead. I stopped going back to him.

My next venture was to a physician (I can’t remember how I got his name), and he prescribed what turned out to be an addictive, highly effective medication that stopped the pain but increased my activity levels 100-fold and had me sweating profusely. It worked, and I was determined to stick with it until it was taken off the market because of its addictive qualities. Sorry, I can’t remember its name. I know a major NYC corporation’s onsite medical office regularly gave it to female employees.

Years later, I would be told how an aunt of mine had similar pain, and while taking her home, my mother met her future husband, who gave the two women a lift home. Yes, it ran in the family.

Still more years later, I discovered we have a genetic anomaly that may cause the pain as well as migraine, depression, miscarriage and a variety of other ailments. But, a researcher told me I shouldn’t worry because there’s a town in Australia where “half of the population has that genetic signature.” Oh, so comforting to know.

Menstrual Pain Known Causes

The evidence is there that women suffer, and there’s a paucity of research on why they suffer from this pain. But the literature has suggested several areas where some research has shown promise as to its roots in their research. Results of this work’s applicability to most women may be sadly limited.

After ruling out physical problems in adolescent females, such as endometriosis, fibroid tumors or underlying pathology, dysmenorrhea is often treated with NSAIDs, hormonal therapy, lifestyle changes and perhaps complementary medicine. The complementary medicines that are most usually recommended are peppermint, cinnamon, ginger and other herbs and supplements.

If endometriosis is a potential cause of the pain, referral to a gynecologist is recommended. The article, however, has an important caveat that indicates the etiology of primary dysmenorrhea is not completely understood…

The presence of a specific genetic configuration was found to be involved in a sample of women who experienced menstrual pain. Those with this genetic component were three times more likely to have pain than those who did not have the genetic condition. Not only did the condition cause pain, it had major implications for education and careers because of the lost days in school and work as a result of pain.

An investigation of a plethora of 566 articles on menstrual pain found that childhood adversity played a role. Sexual abuse and posttraumatic stress disorder appeared to be associated with dysmenorrhea, pelvic pain, and dyspareunia, but it was unclear whether this relationship was mediated by poorer mental health.

Now, those researchers brought in the factor of mental health. Are they intimating that the females had mental health issues that brought on their pain? Is this more “unconscious conflict” possibly about being female? Sounds like a throwback to me.

We are reminded, however, of the paucity of research (as noted in the ResearchGate investigation) on the subject and question the potential skewing of the pool of subjects for the studies. How many of those studies included a genetic component?

Another study looked at postural stability and menstrual pain. Did women who had this pain have difficulties in this area? It seems they concluded they did, but how would that account for the pain? More research needed and they recommended preventive rehabilitation strategies can be given to improve postural stability. Suppose they had included a genetic evaluation and didn’t concentrate solely on postural stability? Would they have come to a different conclusion?

The jury is still out on this one and there is no question that women deserve better information to provide relief that will benefit every area of their lives.

The post Women Suffer Because of Medical Misinformation About Debilitating Menstrual Pain appeared first on Medika Life.

Healthcare professionals have entered a field where empathy, compassion, and an ability to relate well to patients are implicitly mandated. But are some of the staff falling through the cracks, is staff shortage playing a highly detrimental role, or is management falling short in their responsibility to care for patients? Maybe all of it must be factored in, but the bottom line is that patients are suffering from a lack of caring in too many instances.

Additionally, any patients who are older, physically or mentally compromised, may be trained, by brutal experiences, and being a “good patient” is the only way to go. Is that how this is coming to fruition in our fields?

Why should a loved one have to almost plead with a medical staffer to truly “take care?” It’s not my speculation but related in an article in the professional literature.

“I know you have a lot of patients, but he’s all I’ve got. Please take care of him like he’s one of yours.” The partner of my hospitalized patient pleaded.

I remember saying something similar to the chief of a specialized unit at a major NYC hospital. “I’ll take care of her like she’s a family member,” he said, and I responded, “I hope you like your family.”

Cheeky, yes, and he didn’t follow through as I had expected, and an instrument was broken during his procedure — but they persisted. He’s dead now, so no family members need to worry about his ineptness.

The Rocky Road of Care

Why would anyone need to plead in a situation where the highest level of care, concern and personal connection should be the norm? It’s because it’s not the norm, and some staff seems to take umbrage at being expected to be helpful and understanding. Mental status exams after anesthesia might be a case in point.

The patient, who had not been adequately sedated and, as a result, the surgery was canceled because of excruciating pain, tried to lighten the nurse’s load at the bedside.

“Do you know your name,” the nurse asked brusquely.

With an attempt at humor (despite the frightening experience), the patient responded, “Yes, I know my name. Do you?”

Screwing up her face, the nurse asked the question once again.

The patient responded, “Do you want to know my name? I’m trying for a little humor here, as you can see,” the patient said. How the patient managed that, I can’t imagine because she had just come from a harrowing, painful experience that now necessitated yet another, later visit to the OR.

No answer from the nurse but a cold stare. The nurse walked away without completing any further questioning, such as the place, the day, and the date. It was incomplete, but who cares? Who would check, and what would the chart show? A mental status had been administered when it was not completed, a deceitful error.

Before the procedure, a port for administering anesthesia had been inserted into the patient’s arm. A nurse, attempting to pull a gown sleeve up for easier access, inadvertently dislodged the port, and another had to be inserted.

“Look what you’ve done,” the young physician inserting the port (without wearing gloves) said to the patient. The patient had done nothing, but she was being blamed now. Wasn’t she anxious enough without this type of treatment, or was that the usual physician-patient banter before surgery?

Waiting for the procedure to be completed and expecting to take the patient home, there was a query. What was the reason the surgery was canceled? “The patient kept moving around,” was the answer to that question. Again, untrue because it was pain caused by inadequate sedation that led to the patient asking the physician to stop because of the pain, and they both agreed.

I’ve always told patients in my office that they need an advocate for medical consultations or a procedure. I know how anxiety affects memory, and I wanted to ensure they got the information as intended. But in an operating room, you have no advocate, and everyone waits outside to be told whatever is convenient for the staff.

Am I being too harsh? I think not because I saw and heard the entire scenario I’ve described. Where do we go from here? How can we improve patient engagement if we have a resistant staff or management who wants procedures, not re-training in something that doesn’t generate more income?

Patients don’t have unions as medical staff are now seeking. The hospitals pay hospital advocates, so where does their feeling of responsibility lie? Inevitably, the patient will be blamed in some way, either overtly or covertly, and this is not acceptable.

To be continued at some time in the future.

The post Why Is There No True, Empathic Patient Engagement or Is There?” appeared first on Medika Life.

AUSTIN, TEXAS AND FRANKLIN LAKES, N.J. (May 11, 2022) – Babson Diagnostics, a science-first, health care technology company, and BD (Becton, Dickinson and Company) (NYSE: BDX), a leading global medical technology company, today announced the expansion of a strategic partnership to move blood sample collection into new care settings, including enabling patients to collect blood samples at home for diagnostic testing.

Since 2019, the two companies have collaborated to create a capillary blood collection and testing system, now in advanced development, to enable laboratory-quality, small-volume capillary blood collection at retail settings by team members with no previous experience in blood collection. Plans under the expanded agreement include continuing research and development to enable self-collection, mobile services and at-home collection. Babson and BD also will expand the types of blood tests that are possible through small-volume blood collection beyond primary care-oriented tests, and they also plan to develop diagnostic tests for pediatric use.

“Today’s agreement expands our long-standing partnership with BD and builds on our shared passion of making convenient blood testing accessible to all, not only in the U.S., but also globally,” said David Stein, chief executive officer of Babson Diagnostics. “Extending the medical home is critical in today’s health care environment. We believe that retail convenience is perfect for today’s consumer, but because the Babson service is well-suited to many settings with no need for a phlebotomist and an easier collection experience, we see many opportunities for future expansion.”

Over this long-term collaboration, Babson and BD are advancing development of the blood testing ecosystem, which includes BD’s next generation capillary collection technology and Babson’s proprietary automated sample-handling and analytical technologies. These have been designed to work together to enable blood testing that requires only one-tenth the sample volume of traditional venipuncture methods without sacrificing quality, accuracy, or the number and types of tests that are possible.

“This is a paradigm-shifting solution that addresses multiple unmet needs within the current health care system,” said Brooke Story, president of Integrated Diagnostics Solutions for BD. “Because it is less invasive and more convenient than the traditional venous blood draw method, capillary blood collection may lead to an improved patient experience, which in turn could help health care providers see better compliance among patients for routine blood testing.”

BD brings 70 years of specimen management experience to the partnership and is a leader in blood collection technology, including the development of the new, state-of-the-art capillary collection device[i]. Babson provides deep instrument analyzer expertise and is building an ecosystem for blood collection in the pharmacy setting as well as designing the systems and workflows to analyze small volume capillary blood in a central lab. Babson continues to work with local and national pharmacy chains to conduct extensive clinical studies of its service platform in preparation for commercial launch.

[i] The capillary collection device is an investigational device under 21 C.F.R. 812 and requires additional studies to make any definitive conclusions about safety or efficacy

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That is the PG-rated gist of how a middle-of-the-night phone call from a patient’s family ended, and it left me cold. The family member called about a patient admitted to me who was also serving a life sentence at the state prison. As one of the guards who accompanied the patient whispered to me conspiratorially, “I’m not supposed to tell you what he did, but it was bad,” he paused to look me in the eye. “Real bad,” he said with more depth of feeling than I thought those two words could support. “Now he is in for life, so he doesn’t have anything to lose. Know what I mean?” What he lacked in subtlety, he made up for in sincerity. So, yes, I knew what he meant.

So that middle-of-the-night phone call left me shaken, real shaken. Heart racing, pulse throbbing in my ears, tightness in my chest, muscles shivering scared. I tried to convince myself that I was safe and overreacting. I told myself the man on the phone couldn’t possibly know where I lived. After all, my phone number and address were unlisted in the phonebook. But then again, if my phone number wasn’t listed, how did he call me? My attempts to reassure myself and failed miserably.

I made a circuit of the house. I avoided the windows like a character in a spy movie, and I checked that all the doors were locked. I closed the blinds and then rechecked the doors. Then I peeked out through the slot in the curtains.

“Was that car parked on the street there earlier?”

“Is that shadow in the back yard a shrub? Has it always been there?”

I cursed myself for not paying more attention to my environment before this moment, especially now that it could mean the difference between life and death.

I relived the details of the phone call. The caller was irate, that was clear. From there, the one-sided conversation got murky. Reassembling his random, incoherent complaints was like assembling a jigsaw puzzle when the pieces seem to be from more than one set. I’m pretty sure the man on the phone said the patient was his bother. From what I managed to piece together, the caller accused me of conducting experiments on his brother and other inmates and even killing them. He charged me with being the reincarnation of Dr. Josef Mengele, the Nazi Angel of Death, who conducted medical experiments on prisoners in the death camps during World War Two. Not that he ever mentioned Mengele’s name. I doubt the caller knew who Mengele was as the man on the phone did not appear to be burdened by an overabundance of education. What he was burdened by was an overabundance of intoxicating substances. His rant slurred around to the same points so often that even someone with OCD would find it tiresome. The one thing no one would have diagnosed him with was eloquence. His speech stuck with small words, mostly just four letters long. He made up for his lack of verbal breadth by recombining those few words in equally creative and nonsensical ways. If cursing is an art form, then this man is the Salvador Dali of profanity.

Nonetheless, he had used his vast and poorly defined investigative skills to uncover my nefarious plot of torture and murder in the “name of science.” Now that the truth was revealed, he was on a crusade to foil my wicked scheme by well, torturing and murdering me. Logic appears to have taken one look at this conversation and developed such an intense migraine that it went to Aruba to recover for the rest of the week.

He didn’t conclude his circular logic so much as he wore himself out from turning it over so many times. That was when he issued his threat and hung up.

Alone in the dark with my sleeping wife just one room away, my anxiety did not abate, so I did something I had told myself I would never do. I have always been conscientious about my firearms. I know from experience that the gun most likely to hurt you or someone in your house is your own, so I keep my guns out of sight and out of reach. I even keep the ammunition locked away in a separate room. But that night, I violated my rule and loaded five rounds into the pump-action magazine, and those rounds were not birdshot. Then I hid the gun in the back of my bedroom closet.

Unfortunately, that brought me less reassurance than I had hoped, and no sleep came the rest of the night. Instead, I laid there, hyper-attuned to every little sound, both real and imagined. Things always seem less scary in the morning, but when the sun rose, I was still shaken. I pulled one of the penitentiary guards aside at the hospital and told him what had happened.

“You didn’t call them from your personal phone, did you?” he asked like I had just told him I put diesel fuel in my gasoline-powered car.

When inmates from the correctional system enter the hospital, no information is supposed to be given to the family before the prisoners return to the prison. This policy is to prevent impromptu family reunions and breakout attempts. But convicted felons and their families also have fundamental human rights that we must respect. So I had been asked to call one member of the family and explain the medical issues to them. Before making that call, a prison official carefully coached me not to give away any identifying information like my name, the name of the hospital or community, or any details of dates and times. The official did not tell me not to make this call from my personal phone.

“Oh ya, rookie mistake,” the guard said with a shake of his head at my idiocy. At that time, Caller ID wasn’t a standard feature with phones, but an extra you had to pay more to use. I didn’t have caller ID on my phone, but as the officer so sensitively put it, “every dirtball in the country has caller ID.” Then he continued, “well, I wouldn’t worry, usually nothing comes of it.”

“Usually nothing,” proved to be a phrase offering less comfort than I would have liked. It’s like explaining the statistical safety of air travel to someone in a crashing plane. I was well aware that just because most people would be ok in a situation like this did not guarantee I would be.

Despite my sleepless nights, the patient recovered from his emergency surgery without incident and returned to the correctional center infirmary a few days later. I blocked the phone number the angry call had come from, and nothing more ever came of it. But the loaded shotgun sat in my closet for weeks after the event, and my hyper-vigilant attention to any changes in my surrounding persisted as well. I would be startled awake by random noises and lay in bed with a racing heart for some time until I finally was able to get past the event. Time does heal, and eventually, I unloaded the shotgun and put it away, but I did continue to double-check that I locked every door.

I never talked to anyone about this. I didn’t want to look weak or crazy. And that probably wasn’t a good way to handle it because I got a little weird about the phone. I no longer identified myself by name when I answered the phone, and I refused to talk to anyone who didn’t immediately identify themselves, and the purpose of their call, which it turns out is a surprising number of people. My new phone policy resulted in several awkward conversations and one colleague who became quite offended.

“Hello,” said my wife answering the bedside phone in the middle of the night.

“Is Dr. Black there?” said an unidentified male voice.

“May I ask who is calling?”

“I’m calling Dr. Black, is he there?”

“Who would like to know?”

“Is he there?”

“You can reach him on his cell.”

“Damn it, is he there or not!”

Click, buzz. . .

I don’t think it is ever wise for a woman home alone to admit that to an unidentified man on the phone, and given the circumstances, I’m going to stand behind my wife on that one.

The first time I learned about Doximity Dialer, I immediately recognized its benefit. I don’t want to sound like an advertisement for the website I am writing for, but I do use this feature to call my patients. It allows me to call them from my cellphone and display the phone number for my office on the Caller ID. Doing so keeps people from getting my number and then abusing it. If they call back the number on their phone, it goes to my office staff or the answering service. Dialer has proven helpful in dealing with the criminal element and keeping clingy patients from abusing their access to me at all hours of the day and night.

Another critical point is that I should not have admitted a patient like to a community hospital — how that happened is a different story that occurred at the intersection of corporate greed and political ineptitude. How he came to be in my care was not my fault, but it was my problem, and I lacked the experience to deal with the issues involved in caring for someone like this. Worse yet, despite agreeing to take these patients, the hospital lacked the resources to keep its personnel safe. This man proved to be just as dangerous as advertised. When I complained about this to the supervisor from the prison, he explained to me, “The guards only job it to keep the inmate from absconding, its not their job to protect the people who work in the hospital. That is your job.”

It may have been my job, but I lacked the experience, and the hospital lacked the resources needed to do the job right. We are lucky that no one was physically injured, although many were abused in other ways. For my failure to prevent that, I am sorry. As much as young doctors want to be all and do it all, we need to recognize our personal limits and the limits of the system we work. Exceeding those limits is dangerous, not just for the patients, but also for ourselves. There comes a time when you need to say no. It’s not easy and certainly not what we train to do, but sometimes it is the right thing to do.

And finally, whenever you call someone, tell them who you are and why you are calling. It’s just basic courtesy, and that courtesy is there to avoid misunderstandings and hurt feelings.

The post Sometimes You Need to Say No, for the Patient and Yourself appeared first on Medika Life.

All the usual suspects

To identify the root causes, and there are many, we need to examine the engines that power the industry, the healthcare behemoths. The corporate giants that have clawed their way to dominance, many amassing levels of wealth and influence on that journey that place them beyond the reach of even governments. They have become a law unto themselves, and they are without a doubt, what ails healthcare at its heart.

The extent of the wealth acquired by these corporations, their reach, and their influence has been brought home by the pandemic. What has become even more apparent is that the harmonious balance required for an effective relationship between the patient (the customer) and the company (in whatever form) has all but vanished. That relationship, so key to both the health of the industry and the patient, relies on two key elements to function — trust and ethics.

Both of which are absent in modern healthcare in 2022. The blame for the erosion of these elements can be laid squarely at the door of the behemoths. Patients are, for the most part, now viewed by industry as cash cows, rounded up for fattening and subsequent slow exsanguination over the course of their lives. Any loud complaints from the herd and the ranchers simply move the ranch house further from the pens. 

It’s a terrible picture to paint, isn’t it, and one many healthcare experts would deride as being a ridiculous representation of the industry. Nothing could be further from the truth.

In an article by NPR which hit the headlines in the last week, a baby powder produced by one of these companies contained carcinogenic asbestos, which, had unfortunately found its way into their powder during the production process. Sadly, by the time the product has been removed from shelves, consumers had been diagnosed with cancers. A class-action was brought against the company by the affected customers, seeking some form of redress or compensation. Faced with a choice of paying settlements, the company elected to pursue a legal loophole.

In a shuffle, known in legal circles as the Texas Two-Step, they registered a new company in Texas, shifted all onus for the product claims to the new division, and then filed for its bankruptcy, effectively killing off the hopes of any potential payments to their affected customers and ending the class action. As appalling as this is, it is an acceptable legal loophole which many companies use, in itself an indictment of the American legal system. The existence of the loophole, however, does not excuse the ethics of the companies prepared to engage it.

Profits are protected at any expense, with trust and ethics forgotten, and therein lies the problem. These companies aren’t selling us cars or cellphones. They are, in many instances selling us products that can cure our ills, extend our lives or potentially kill us, and in medicine, where that product ends up on that scale can often be a fine line.

So trust matters, hugely so. Breach it and you better have a damn good reason, supported by an ethical and transparent response to any harm you’ve caused. The fact that lawyers make a living off class actions aimed at these companies speaks volumes to the behemoth’s disregard for the customer and their wellbeing. Engage in legal shenanigans to avoid that responsibility and then offer me your Covid vaccine with the assurance it’s safe. 

The Power of the People 

If we then assume that much of what ails healthcare can be resolved by addressing and regulating the business practices of these corporate giants, that leads us to the title of this piece. Can these companies be “saved” or are they too far gone, despotic dictators obsessed with their own self-inflated worth who’ve lost the ear of their people? I tend to believe the latter.

The public is rediscovering their voice in terms of their health, determining outcomes, and engaging in the processes that surround their treatment. I use the term public and patient interchangeably, as any member of the public is, was, or will be a patient at some stage in their lives. We all require healthcare, no matter our status, race, or sex.

This patient-centric movement sweeping through healthcare is long overdue and has been birthed as a direct response to much of what I have described above. Taking that as a given, logic dictates that a popular movement that arises in response to a dictatorship will not endeavor to change the minds and hearts of its despotic rulers. Complete regime change is called for, and almost always results. You cannot fix something that is fundamentally broken and no longer fit for purpose. The behemoths have served their purpose and must be retired. For the sake of the patient and healthcare globally, we need to start afresh.

If we look to oust the current regime, how do we then harness this new force sweeping through the industry? How best do we use the momentum of the patient voice to engage lasting solutions?

At the risk of buying into trending catch phrases, decentralization of the industry is key. Redistributing the power amassed by the few among the many. Smaller, more focused companies that address specific needs, specialists in their chosen fields, offering tailored solutions to the real issues affecting the development and delivery of equitable and accessible health care. In short, a new model of care and delivery, built from the ground up with patients actively engaged as masons. And yes, ethical businesses that place their customers’ interests first and foremost can be profitable.

It isn’t simply the patients that stand to benefit from this change. Make no mistake, the egregious travesties visited on healthcare by these large corporations extend beyond the patient and has ensnared providers, who are in many ways, products and prisoners of the environment they are forced to function within. Patients looking around their lifeboat will find themselves surrounded by white coats.

I’d like to end this with a few probing questions, directed to the industry in its entirety. What happens when the next pandemic strikes, an event that is inescapable? How, at that point do we convince the global population that any potential treatment we’ve developed is in fact fit for purpose? How, when we currently engage in deceitful and dishonorable practices and place the acquisition of wealth before the interests of the very population we’re sworn to protect, do we reclaim our credibility? How do we rebuild and regain trust?

Now is the time to build afresh from the ground up, as many promising new start-ups are doing. We have the technology, the intellectual capital, and the desire. Time will show if we possess the will.

The post Are Healthcare’s Behemoths Destroying Healthcare? appeared first on Medika Life.

Genetics were against him. His father died at 58 and an older brother died at 61, both of heart disease. To manage his cardiovascular risks, my father-in-law embraced prevention through diet and exercise, and relied on science and medical adherence – even successfully seeking an ablation for a reoccurring arrhythmia as he neared 90. His actions enabled him to exert a measure of control over his life journey.

Throughout that journey, his medical care was exemplary, but during the final 13 days of his life – 12 spent in a hospital and the last precious day at home, where he passed peacefully from one world to the next, surrounded by people who loved him with all their hearts – I saw what America needs to do to improve care, comfort and costs. I saw that even in state-of-the-art care settings, much work needs to be done to improve collaboration and performance in the service of the patient.

Seven years ago, I penned a piece on the fragmented medical system. I wrote that our system of care is not patient-centric, it is self-centered.  While the intention of health professionals to help and heal is exceptional, it’s unclear whether the system they work within is set up to enable them to succeed in complex care situations.

When Finn Partners released a survey in February 2016 on our fragmented health system, I wrote that despite “the talk, the concept of consumer – in this case, the patient – as the king has yet to be realized within the health community. Health professionals, payers, the pharma industry and policy decision-makers have a responsibility to be better patient resources. Providing a clearer path for patients to navigate the system may improve outcomes and reduce costs – it’s still a missing magic ingredient.”

Respect for Patients Must Be At the Heart of Care

Staff is overstretched everywhere now, and that impacts collaboration and coordination of care. One nurse’s comment in response to information shared by one of my father-in-law’s caregivers exemplified this persistent and underlying problem: “I don’t have time to read the My Chart (EHR) file.”

During the 12 days my father-in-law was hospitalized, he had different 10 nurses assigned to oversee his care. The hospitalist assigned to him changed three times.  The nephrologist also rotated. Staff overlooked the sign posted over my father-in-law’s bed that stated: “Make Sure Patient Has Hearing Aids On,” and diagnosed him with cognitive challenges.  And, despite the sign and constant caregiver reminders to floor staff, they first lost one of his hearing aids and then the other days later – $6,000 of high-tech that had connected him to the world, gone.

Forget Interoperability Nurses Have No Time to Read EHRs

If care providers do not have sufficient bandwidth to read about the medical history of their patients, you can forget about interoperability playing a role in improved care. If the system does not demand that caregivers look over recent tests conducted by other physicians – or allow them the time to do review – then you can forget the optimal use of resources.  No matter how innovative medications, treatments or modalities of care are, if these elements aren’t being effectively coordinated for the patient, those therapeutics may as well not exist.

My friend and industry colleague John Nosta, an innovation theorist, often says, “Cultures crushes innovation.” These past two weeks, I once again saw the “Nosta Theory” at work.  To be clear, we should not be pointing the finger of blame for this situation at physicians, nurses or allied health professionals on the hospital floor. Healers want to heal just as much as those who are ill want to be helped.  But care professionals have to work within the system that the hospital creates, and if the system does not support their efforts or make the best use of their abilities, energy and dedication, what is to be done?

Change Starts with Awareness

In one of three books that he published, my father-in-law, an internist, psychiatrist and sports psychologist, wrote: “When people say, ‘I’ll never change,’ what does that mean? They might mean, ‘I’ll never be able to change my awareness.’ And they may not realize that such a change is often the first step in changing other aspects of their experience.”

The United States boasts one of the most advanced health systems in the world, and leaders within the system seem fully aware they need to change. It’s time to build on that awareness and take critical steps toward improving health delivery and coordination of care – and to move from a system that leads directly to health professional burn-out, avoidable deaths, and spiraling care costs to one that puts people – patients and their caregivers – first.

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[This Medika.Life article is dedicated to caregivers, who advocate for their loved ones with courage and hope. It is dedicated to patients who must secure their place at the decision-making table. It is dedicated to health professionals who must be given both the tools of innovation and the supportive culture of collaboration to do their best possible work toward healing.]

The post Cutting-Edge Innovation Is Not Enough To Save Lives appeared first on Medika Life.

Brad has served in leadership roles at EvergreenHealth, Cue Health and Shift Labs. His 20 years of experience as a doctor, ongoing work as an emergency physician and medical director of emergency preparedness, trauma and urgent care make him uniquely qualified to envision the quality of service for those seeking immediate care need.

Saving lives is a survival instinct for Brad. He earned a Bronze Star and Combat Medic Badge for his service in Iraq as a United States Army physician, and those experiences have enabled him to think about healing a fragmented system of care to make it far more responsive to patient needs.

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Gil Bashe: You and I both served in an army medical corps, you as a surgeon with the US Army, and I as a frontline paratrooper combat medic. We both had dramatic experiences in providing care. I went out with our soldiers to treat them where and when they were wounded. Fast forward, you served during the Iraqi War, when great technological advances in medical care were available. You saw that medical personnel were deployed piecemeal, and care was fragmented and provided by scrambling to get to patients. Tell us a little bit more about how those experiences framed your vision for patient care?

Brad Younggren: I completed my residency after September 11 (2001) and then joined the US military. Suddenly, I found myself transported to the middle of a major conflict as a squadron surgeon for a reconnaissance unit along the Syrian border.

When I arrived, the doctors and physician assistants were stationed in different places along the front. I couldn’t understand why. I thought: “We have helicopters, portable ultrasound machines, and video calling capabilities. Wouldn’t it be more strategic to position ourselves in Tal Afar, which would allow us to get to soldiers more quickly?”

Bashe: So, you saw the capability to use resources more effectively to treat patients faster to save lives. You recognized that you also had the technology to connect to the front-line instantly. What did that realization inspire you to do?

Younggren: When I saw critical time wasted and providers pushed to the point of injury, that launched this notion to use technology to save soldiers’ lives. When I returned stateside, I dived into technology visualization procurement for the Army. If we have devices that are durable enough for deployment that can extend our reach, we shouldn’t need to risk doctors’ lives by stationing them in Baghdad. Why not place them strategically in locations where they can sustain and save lives using technology at major medical centers such as Walter Reed Medical Center?

In 2010, I got out of the military and went to work for a company that developed the first Food and Drug Administration (FDA)-approved mobile-phone device. Now, we take for granted that a cell phone has better visualization than a hospital monitor. At that time, that wasn’t the case. That’s when I got my first taste of just how great an impact technological evolution could have on patient care.

Bashe: Can you expand on your decision to join 98point6? You saw the potential of technology to transform military medicine. Is the civilian world of urgent care very different? Why do you feel those in the healthcare profession must use technology to bring the primary care physician closer to the patient?

Younggren: As an emergency physician, I saw several failures within the healthcare system. During my time in the military, I saw how technology accelerated and could be leveraged to meet urgent medical needs. I recognized the need to build a technology platform that provides on-demand service at the point of care that also would reduce physician variability in practice.

Instead of repeatedly trying to get doctors to do something with an off-the-shelf digital plan, the only way you can impact change and care is to put technology tools and data directly into the hands of the doctor. Then they can make the best clinical decisions when they need to, in real-time.

Bashe: We both know how hard it is to change the healthcare system. You may need to push new ideas while old ones are still firmly in place. Tell us how the 98point6 platform is working to effect changes that will eventually transform the system?

Younggren: One of the primary reasons I came to 98point6 was to be the first point-of-care company in the room during every single patient visit. Almost all of our patient cases are handled via text (with support for photo/video as needed for diagnosis). We can capture all of the conversational information that occurs between doctor and patient, which informationally and procedurally, is incredibly powerful. If you want to understand how to impact the care delivery system, you need to fully understand the interaction: you need to be in those rooms.

Our Chief Product Officer Robbie Schwietzer helped build Amazon Prime. His acute understanding of consumer engagement played an integral role in the development of our platform. We are committed to providing a pleasurable experience that gets people the care they want and need.

That’s key to the transformation of care, and we have patients tell us all the time how easy-care is for them now. They’re on a bus or in a meeting when they’re engaging in care, and that’s the beauty of it. You don’t even need to be on video: you can access care from physicians in an incredibly convenient, nondisruptive way. And that’s going to change how consumers want to get care, and how they expect to access it.

Bashe: Most certainly, you are familiar with Dr. Eric Topol’s book “The Patient Will See You Now?” Is 98point6 the transformation from question mark to exclamation point to the polemic he raises?

Younggren: Yes, I’ve read the book and considering Eric’s view that the smartphone is the agent for transforming care, and digitally empowered patients can take charge of their health care, I hope that he would believe that we are the kind of “bottom-up” care that he envisioned.

Ultimately, we’re a technology-driven, care-delivery platform where every case is backed by a doctor. We’re leveraging our technology and physicians to deliver better patient outcomes because that’s truly where the magic happens.

Bashe: Tell me about the 98point6 physicians. Do they take on 98point6 work in addition to their private or group practices? Or are they dedicated to pioneering this sort of connective technology with patients?

Brad Younggren: It’s the latter. I spent a lot of time looking at the market and found that physicians are on the outside looking in. To build an AI platform where the AI is learning from the behavior of the physicians, and to deliver care in 51 jurisdictions on demand, we needed a cadre of dedicated, on-staff physicians.

With these goals in mind, we couldn’t rely on locum doctors, which most of our competitors do. We needed to train our doctors to properly use technology. Originally, we started with seven and now we’re up to approximately 50 full-time, board-certified physicians. We augment the full-time physician team with part-time, directly employed board-certified physicians who meet the same hiring bar and receive the same training.

Bashe: Going back for a minute to our shared past in military triage, how do you deal with the triage of specific health needs within the 98point6 system?

Younggren: We have a whole team that’s devoted to continuously improving virtualized or AI-based triage, and one of the angles we’re taking is how to triage based on acuity and immediacy of need, which is very similar to being an aide in an emergency department. We’ve already built AI-based tools to help identify suicidal patients and pull them up to the top, so you can locate the patients that need care most immediately. Even though we’re aiming to provide on-demand care for all patients, it still requires a bit of clinical triage.

We do employ some doctors part-time who can help fill in gaps as needed from a capacity perspective. Ultimately, we want all the doctors we employ to work for us forever, so any work we can do to make their lives better from the perspective of preventing burnout is really important to us. At the heart of it, we’re a physician-forward organization. We track their satisfaction scores and constantly ask what we can do to make their experiences better.

Bashe: Describe the relationship between the primary care provider and the patient from a technological standpoint. Do you feel that 98point6 has maintained a relationship there or is it more functional than anything?

Younggren: Our theory at the beginning was based on research in computer science that shows patients can develop relationships with technology. Because we’re on-demand, it’s basic to our system that patients develop a relationship with 98point6 versus our physicians — it’s simply unrealistic for each of our doctors to work 24–7. We constantly strive to provide a peerless experience for patients that builds a level of trust with the brand, regardless of the physician on duty.

Bashe: In this country, 90 million people are pre-diabetic, but only 1 in 4 know that are trending toward diabetes. If 98point6 has a relationship with the customer, and you see that they’re pre-diabetic, do you simply say your blood glucose is a little high, you should be more mindful? Or do you preemptively engage that patient/customer?

Younggren: At the most basic level, we’re focused on invoking the standard guidelines of preventative care. So, let’s say a patient is 45 years old with a family history of colon cancer. We can catch that and recommend a colonoscopy, especially if they’ve never had one. There’s still a lot more work to be done in making preventative care more effective, as well as care navigation, chronic disease, behavioral health and we’re constantly looking to improve these areas.

Bashe: How do you feel about empowering faster engagement and the use of artificial intelligence, or even a medical chatbot to do so?

Younggren: There are a lot of symptom-based chat boxes on the market, and this technology isn’t inherently connected to a doctor. Even if a chatbot supplies the top four diagnoses to a patient, when a physician comes into the picture, they still have to backtrack to understand what has happened in that technology experience to build trust, provide an accurate diagnosis, and determine the next steps. That takes additional time and effort, and patients feel that.

I believe you need physicians trained to use technology that is fundamentally connected to the practice of medicine. In that case, technology is extending the reach of a physician’s hands and it’s a pretty cool, proven approach.

Bashe: I noticed that you’ve been tapped by major corporations as their medical service partner of choice. What’s the driving force behind these partnerships?

Younggren: One of the great things about working with employers is that we make a real concerted effort to understand their challenges and the problems their employees face. For instance, when the pandemic hit, we had to figure out a way to support employers with COVID testing in several different contexts.

Large employers trust us to give them high-quality care, but it goes beyond that. We’re having meetings regularly to better understand what their pain points are and where we can use technology to make the greatest impact. Many times, patients don’t know the extent of their medical benefits, but we know exactly what their plans are, and can recommend other services they might need, whether it be substance abuse support or behavioral coaching, that they’re not even aware they can access.

That additional ability to increase the utilization of other services these employers are paying for is a win-win for employers and their employees, who can further improve their health and enhance their quality of life.

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As an experienced combat physician and trauma care specialist, Dr. Brad Younggren — applying technology to accelerate access to care — demonstrates the digital transformation occurring in the health ecosystem. He is centering medicine around the patient and selecting to reinvent care, not by planting technology into a system seeking to keep it away at arm’s length, but rather by inviting physicians who select to be on the frontlines of care to use innovation to improve people’s wellbeing.

The post People Needing Access to Care Shouldn’t Have to Do Battle to Get It appeared first on Medika Life.

Too often, assumptions are made once a wrinkled face or sun-blotched, loose skin is seen, and the patient’s age screams out from an intake form. Is it any wonder people don’t want to tell anyone their age? Or that they avoid medical care? Would you gladly subject yourself to this boorish behavior?

A 63-year-old woman in a skilled nursing facility summed it up as she said she feels like “I’m invisible” and like she’s seen as “a slug in a bed, not a real person.” Only one nurse regularly talks to her and makes her feel she cares about (her) well-being….”Just because I’m not walking and doing anything for myself doesn’t mean I’m not alive. I’m dying inside, but I’m still alive.”

Healthcare discrimination can be seen in “one out of five adults over the age of 50 years (who) experience discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with
new or worsened disability…”

Discrimination is associated with age, financial status, and gender, and the longer the person is in the facility, the worse the discrimination becomes, especially for those with ADL disabilities.

I saw an older woman in an upscale residential nursing facility years ago. The woman was walking up and down the hallway, mumbling to herself. When I stopped to talk to her, the words she uttered were gibberish, and I wondered if there might be a problem with treatment.

She was well-educated, had been a nursing supervisor in a major university hospital, and now she was seen as beyond treatment for her mental decline. The treatment they used was exclusively antipsychotics. I didn’t think sufficient exploration had been initiated, and I found a geriatrician to whom I referred her family.

Within days of a medication change, she was verbal, going out to dinner with her family and helping other residents as any nurse would. The house physician (a resident from a local hospital) and the staff had written her off before this new treatment regime.

Where might the bias be in terms of the elderly and other groups receiving reinforcement? Perhaps one source is in medical residency programs. Do older women wish to be referred to as “cute, little old ladies?” What are the equivalent terms used for men?

Unlike racism or sexism about which there is considerable contemporary discourse related to diminishing bias and stigma, ageism has not been widely recognized as an area of social concern…Ageism is prevalent in medical education clinical settings and in the “hidden curriculum.”

AI Is Not Rooting Out Bias

Medical bias exists and persists and is being incorporated into AI databases where it will reside and infect other software platforms. Demographic healthcare inequalities continue to persist worldwide and the impact of medical biases on different patient groups is still being uncovered by the research community.

Who checks these current or future artificial intelligence databases to ensure that they do not contain bias against the elderly or other groups? Realistically, they may not be able to go back and find the initial programs that were tainted by bias; it’s a soup of programs.

Even the programmers may not realize where the code sits in the thousands of lines of code produced for one program and then another formed from that code. What might be needed?

Instead of seeking bias in current AI code, there may be a need to write whole new programs to address the bias. In addition to code, what else is needed now?

Webinars can be a potent source of information if healthcare professionals tune in to one like “Confronting Ageism in Health Care: A Conversation for Patients, Caregivers, and Clinicians.”

How many healthcare professionals keep up with knowledge in this area? Who would know if they didn’t? Families are left believing that the treating physicians are knowledgeable, but they may not be, and therein lies the tragedy. Look at the example I provided at the beginning of this article.

One group where anyone can find qualified professionals as well as valuable information is the American Geriatrics Society. Any questions that may arise regarding an older patient may need to be referred to a specialist.

The body’s many systems change with age and may become more sensitive to side effects, including memory impairments, panic disorders, and liver and kidney changes. One slip of memory may be seen as an indication of dementia when all of us have these moments of memory lacks without being demented. One woman I knew was malnourished, which affected her memory. Diet was the solution, not memory-enhancing drugs or antipsychotics.

The situation requires improvement, but it will only happen with self-awareness and there is a concerted effort by staff in medical schools and residencies to address it. If the “silver tsunami” is fast approaching, how will it be received? Life spans may be longer even with Covid-19, which brings a need for educated and unbiased attention to the physical and mental health needs of older adults.

There are at least a half-million people in the world over 100 in 2021. With improvements in medical research, that number will increase. How will they be treated and cared for in residences or their homes?

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